The goal of this feasibility clinical trial is to assess the acceptability of ultrasound-guided sciatic nerve block when performed at Emergency Departments for manipulation and temporary stabilization of distal leg and ankle fractures.

The trial aims to assess:

• The acceptability of sciatic nerve block
• The technical feasibility of sciatic nerve block
• The technical success of sciatic nerve block
• The analgesic efficacy of sciatic nerve block

In addition to that, this study aims to

• Describe patient-reported and physician-reported satisfaction
• Assess the Adverse Event rate at 48 hours post intervention

Inclusion Criteria:

• Age >18
• Confirmed radiological diagnosis of distal tibia fracture (Group 43 according to AO classification, all subtypes included); or malleolar fracture (Group 44 according to AO classification, all subtypes included); or distal fibula fracture (Group 4F3 according to AO classification, both the two subtypes included); or any combination of the fracture patterns described
• Fractures requiring manipulation in the ED to achieve temporary stabilization either as manual reduction and cast immobilization; or calcaneal pin traction (as per local policy or treating physician's preference)
• Capacity to understand the aim of the study, the potential benefits and harms of the proposed intervention
• Capacity to provide consent
• Capacity to provide a self-assessment of pain using the written VAS Scale

Exclusion Criteria:

• Fractures that do not require any form of manipulation in the ED according to the treating physician (e.g., fractures with minimal or no displacement of the bony fragments, that are immobilized in a posterior leg cast by the nursing stuff/physicians assistants without any painful manipulations of the bony fragments performed by the physician)
• Open fractures
• Perisynthetic or periprosthetic fractures
• Distal leg/ankle fractures with neurovascular compromise
• Clinical signs of compartment syndrome
• Skin infection at the needle entry sites
• Diabetic neuropathy or any other known form of neuropathy that causes reduced sensation in the sciatic and/or femoral nerve territory
• Charcot-Marie-Tooth disease
• Known allergy to local anaesthetics or opioids
• Hemodynamic instability
• Known diagnosis of severe cognitive impairment
• Dementia and/or delirium (defined by a 4AT score ≥ 2)
• Lack of capacity to provide consent and to understand the aim of the study
• Patient's refusal to participate in the study
• BMI>35
• Body weight < 40 Kg